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JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
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I was able to see the problem as well when I checked your jotform http://www.jotform.us/form/52227852883160
Unfortunately, the theme used on the form seems to have been corrupted which causes several anomally in the styling of the form fields.
I was able to create a fixed form by removing every thing and creating the form again from using the Field Manager App.
Here is a fixed version of the form http://form.jotformpro.com/form/52558086205962?
If OK with you, you can just clone my fixed form so that it will be added on your account.
Follow this user guide: http://www.jotform.com/help/27-How-to-clone-an-existing-form-from-your-account
Please let us know how we can assist you further.
Thank you for your response. I just started with a new one of the forms
that already had the date and time and took it from there.